Pre-emptive Diclofenac Versus Ketoprofen as a Transdermal Drug Delivery System: How They Face

Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide

OBJECTIVE

This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery.

METHODS

The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery.

RESULTS

This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted.

CONCLUSION

Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.

Analgesic Efficacy of Ketoprofen Transdermal Patch versus Ibuprofen Oral Tablet on Postendodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial

Materials and Methods

In this randomized clinical trial, 64 patients who had mandibular first and second molars with irreversible pulpitis were randomly divided into two groups (n = 32) by stratified permuted block randomization. The experimental group used 60 mg KTP every 6 hours, and the control group received 400 mg ibuprofen tablets every 6 hours for 1 day. The severity of pain experienced by patients was quantified before and at 2, 4, 8, 12, 24, and 48 hours after endodontic treatment, using the numerical rating scale (NRS). Data were analyzed by using the t-test, Mann-Whitney test, and generalized estimating equation (GEE) (alpha = 0.05).

Results

The pain score was not significantly different between the two groups at the baseline or any other postoperative time point (P > 0.05). The reduction in the pain score was significant in both groups from 2 to 10 hours and 10 to 48 hours, postoperatively (P < 0.001). The interaction effect of time and group was not significant on the postoperative pain score in the abovementioned time intervals, and the pattern of pain reduction was the same over time in both groups (P > 0.05).

Conclusion

Both KTP and ibuprofen effectively decreased postendodontic pain. Considering the comparable pattern of pain reduction, KTP can be used as an alternative to ibuprofen tablets for effective pain control after endodontic treatment of mandibular first and second molars with irreversible pulpitis.

Pre-emptive Analgesic Efficacy of Single-Dose Transdermal Ketoprofen and Diclofenac Patches in Post-operative Pain Management Following Open Treatment of Mandibular Fractures: A Randomized Controlled Study

INTRODUCTION

The present study was deliberated to assess the pre-emptive analgesic efficacy of diclofenac sodium and ketoprofen transdermal patches following open treatment of mandibular fractures.

METHODS

The present prospective, triple-blind, randomized controlled clinical study was carried out on 50 male patients with a mean age of 30-31 years having bifocal mandibular fractures. The subjects were assigned 1:1 to two groups; group K - ketoprofen group and group D - diclofenac sodium group. Patches were applied according to the group allocation one hour before induction. In the immediate post-operative (PO) phase, pain intensity was recorded using a 10-point Visual analog Scale at 2, 4, 8, 12, and 24 hourly. Statistical analysis was performed using descriptive and inferential statistics using SPSS 27.0 version (IBM SPSS, Armonk, NY) and GraphPad Prism 7.0 version (GraphPad Software, Inc., La Jolla, CA) and p<0.05 is considered a level of significance.

RESULTS

The present study demonstrated a statistical difference in mean pain intensity among both groups, with lower pain scores at all time intervals and fewer rescue analgesic consumption in the ketoprofen group.

CONCLUSION

The ketoprofen transdermal patch was found to be superior in comparison to the diclofenac patch in terms of providing optimal post-operative analgesia with a reduced requirement for post-operative rescue analgesics and minimal adverse events.

Plasma proteomic changes in response to surgical trauma and a novel transdermal analgesic treatment in dogs

Assessment of pain responses and inflammation during animal surgery is difficult because traditional methods, such as visual analogue scores, are not applicable while under anaesthesia. Acute phase proteins (APPs), such as C-reactive protein and haptoglobin, that are typically monitored in veterinary research, do not show a significant change until at least 2 h post-surgery and therefore, immediate pathophysiological changes are uncertain. The current study used sequential window acquisition of all theoretical mass spectra (SWATH-MS) to investigate plasma proteome changes that occur immediately following surgery in dogs and also to assess the efficacy of a novel transdermal ketoprofen (TK) formulation. Castration was chosen as surgical model in this study. The procedure was performed on twelve dogs (n = 6 in two groups) and blood samples were collected at 0 h, 1 and 2 h after surgery for proteomic analysis. Following surgery, there was a general downregulation of proteins, including complement C- 3, complement factor B, complement factor D, transthyretin, and proteins associated with lipid, cholesterol, and glucose metabolisms, reflecting the systemic response to surgical trauma. Many of these changes were diminished in the transdermal group (TD) since ketoprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostanoids and the associated chemotactic neutrophil migration to site of tissue injury. SIGNIFICANCE: SWATH-MS Proteomic analysis revealed significant changes in plasma proteins, predominantly involved in early acute phase and inflammatory response at 1 & 2 h after surgery in castrated dogs. Pre-operative application of transdermal ketoprofen formulation had reduced the systemic immune response, which was confirmed by negligible alteration of proteins in transdermal treated group. A key outcome of this experiment was studying the efficacy of a novel transdermal NSAID formulation in dogs.

Pharmacokinetic Evaluation of a Novel Transdermal Ketoprofen Formulation in Healthy Dogs

Dogs undergo various surgical procedures such as castration, ovariohysterectomy, and other orthopedic procedures, which are known to cause inflammation and pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are very effective analgesics for alleviating postoperative pain in veterinary medicine. Ketoprofen is currently approved in Australia and the United States for treating different painful conditions in dogs. This study evaluated the pharmacokinetic parameters of ketoprofen after intravenous (IV) and transdermal (TD) administration in healthy dogs. A novel transdermal ketoprofen (TDK) formulation containing 20% ketoprofen, dissolved in a combination of 45:45% isopropanol and Transcutol, along with 10% eucalyptus oil, was developed and evaluated for in vitro dermal permeation using Franz diffusion cells. A crossover study was then conducted to determine the pharmacokinetic parameters of the formulation in six dogs following IV ketoprofen (1 mg/kg) and TDK (10 mg/kg) administration. A liquid chromatography–mass spectrometry (LC-M/MS) method was used to measure plasma concentrations of ketoprofen over time, and a non-compartmental analysis determined the pharmacokinetic parameters. The mean terminal elimination half-life (T_½ h), AUC_0-t (µg·h/mL), and mean residence time (MRT, h) between IV and TDK groups were 4.69 ± 1.33 and 25.77 ± 22.15 h, 15.75 ± 7.72 and 8.13 ± 4.28 µg·h/mL, and 4.86 ± 1.81 and 41.63 ± 32.33 h, respectively. The calculated bioavailability (F%) was ~7%, with a lag time of 30 min to achieve effective plasma concentrations after the application of TDK.

Efficacy of Transdermal Diclofenac Patch and Ketoprofen Patch as Postoperative Analgesia after Extraction of First Premolars Bilaterally in Both Arches for Orthodontic Purpose: A Comparative Study

Aim:

The aim of the study was to compare the efficacy of transdermal diclofenac patch with ketoprofen patch as postoperative analgesia after extraction of first premolars bilaterally in both arches for orthodontic purpose.

Materials and Methods:

A split-mouth technique was used in 52 patients with the age group of 15–25 years for extracting maxillary and mandibular first premolars bilaterally for orthodontic reason. A single ketoprofen patch was used after the extraction of premolars from first and fourth quadrant, whereas for the extraction of second and third quadrant premolars, diclofenac patch was used. All the extractions were performed under local anesthesia. The data were compiled and statistically analyzed using the student's t-test.

Results:

Mean visual analog scale score for diclofenac and ketoprofen patch was 2.05 (0.75) and 1.09 (0.3), respectively. Thirteen patients required additional medication (25%) and 1 (1.9%) patient with diclofenac and ketoprofen patch, respectively. No major complication or adverse effects were observed in any of the groups.

Conclusion:

Both diclofenac and ketoprofen transdermal patches are helpful in relieving pain after orthodontic extraction. Patients with diclofenac patch required more additional analgesia within 24 h compared to that with ketoprofen patch. None of the drugs showed any significant adverse effects and were well tolerated by the patients.

Evaluation of the Efficacy of Regional Anesthesia and Intramuscular Diclofenac in the Management of Postoperative Pain: A Comparative Study

Aim:

Managing postoperative pain following maxillofacial surgery is an important task. Our study aims to compare this with regional anesthesia or IM diclofenac.

Materials and Methods:

This study included 30 patients who underwent bi-jaw orthognathic surgery between April 2016 and January 2020. Two groups were formed. Group A was administered inferior alveolar nerve block at the surgical site bilaterally using 0.5% ropivacaine and Group B were administered 75 mg intramuscular diclofenac just before extubation. Tramadol HCl 2 mg/kg body wt is used as a rescue analgesic. The pain was evaluated periodically at 2^nd, 4^th, 6^th, and 12 h postoperatively.

Results:

The mean Visual Analog Scale score was 2 in Group A and 5 in Group B. The mean duration of analgesia was 6 h 42 min, whereas in Group B, it was 8 h and 5 min. In 2 patients (13.3%) belonging to Group A and 3 patients (20%) belonging to Group B. There were no local complications in any group.

Conclusion:

It was observed that regional anesthesia in the form of intraoral nerve blocks was efficient than diclofenac (75 mg) administered intramuscularly for the management of immediate postoperative pain.

Comparison Between Efficacy of Transdermal Ketoprofen and Diclofenac Patch in Patients Undergoing Therapeutic Extraction-A Randomized Prospective Split Mouth Study

PURPOSE

Postoperative pain control is a significant aspect of patient treatment after an oral and maxillofacial surgical procedure. The use of a transdermal patch is one such method to provide postoperative analgesia. The present study was undertaken to investigate the efficacy of a single-dose transdermal patch of ketoprofen compared with that of diclofenac postoperatively after therapeutic extraction of first premolar teeth for patients undergoing orthodontic treatment.

PATIENTS AND METHODS

A split mouth randomized clinical trial was conducted of 40 patients aged 15 to 25 years who had required therapeutic extraction of both maxillary and mandibular first premolar teeth bilaterally. A single ketoprofen patch was applied for the first and fourth quadrant extraction, and diclofenac patch was applied for the second and third quadrant extraction after atraumatic therapeutic exodontia at 2 consecutive appointments with the patient under local anesthesia. The data were obtained and analyzed using the Student t test and Shapiro-Wilk test using SPSS software (IBM Corp, Armonk, NY).

RESULTS

All 40 patients who had received a single-dose ketoprofen patch had experienced less postoperative pain and did not require a rescue analgesic with a mean visual analog scale (VAS) score of 1.13 ± 0.335 (P < .00001). The patients who had received a diclofenac patch reported comparatively elevated pain scores in the initial 24 hours, with a mean VAS score of 2.0 ± 0.5064 postoperatively, and 20% of the diclofenac treatment arm had required a rescue analgesic. No complications were observed among the patients postoperatively in either treatment arm.

CONCLUSIONS

Both the ketoprofen and diclofenac transdermal patches were effective in achieving postoperative analgesia in patients after therapeutic extraction, with ketoprofen superior to diclofenac as a transdermal medicament.